Provider Demographics
NPI:1891998498
Name:MCMULLEN, JOHN LAIRD III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAIRD
Last Name:MCMULLEN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:734 N 3RD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5285
Mailing Address - Country:US
Mailing Address - Phone:352-365-2583
Mailing Address - Fax:352-728-6749
Practice Address - Street 1:801 E DIXIE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7699
Practice Address - Country:US
Practice Address - Phone:352-365-2583
Practice Address - Fax:352-728-6749
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2016-02-24
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Provider Licenses
StateLicense IDTaxonomies
FL938482085R0204X, 207RM1200X
FLME93848202K00000X
FL938492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000070900Medicaid
FLP00656356OtherRR MEDICARE LMIV
FLP00656364OtherRR MEDICARE RACF
FLAL343YMedicare PIN
FLAL343ZMedicare PIN